modifier 25

  1. K

    Wiki modifier 25 reduction

    Has any had there office visit reduced by 50% because the use of modifier 25? i had a claim processed by medishare where we did the 69210 and 99214-25, the ov was reduced from 80 allowable to $40 because of hte use of modifier 25 reduced at 50%. i can't find any new rules except a article from...
  2. N

    Wiki Unrelated E/M with procedure

    Hi, general question... Is it appropriate to bill an E/M -25 when its unrelated to the primary procedure on every visit? It's not bundled due to both codes being unrelated. For example, patient comes in for debridement 11042 on right ankle, but provider treats edema in another area which is new...
    • nittamarable
    • Thread
    • e/m e/m with modifier 25 e/m with procedure evaluation & management followup modifier 25 ncci ncci edits unbundle wound care
    • Replies: 5
    • Forum: E/M
  3. N

    Wiki Bundled Office Visit w/ -25

    We have been getting denials recently from Humana when billing 99214-25 (I70.233, F17.218, I89.0) 11042 (L97.312, L97.212, T81.31XA) Dx are different for each code. Only thing I can think of is the i70.233 and L97 codes both address the 'right leg' .. BUT we have been getting paid before with...
    • nittamarable
    • Thread
    • 11042 11042/11045 99214 billing debridement e/m e/m with modifier 25 humana modifier 25 office visit
    • Replies: 2
    • Forum: Billing/Reimbursement
  4. KStaten

    Wiki Repeat Injections with E/M Codes

    Greetings Fellow Coders! :) Scenario: A new patient is evaluated and found to have OA of the left knee. On that visit, the physician decides to perform an injection and bills an E/M (99203) with a modifier 25. At that visit, the physician does not "plan" another injection. If the patient...
    • KStaten
    • Thread
    • e/m injection modifier modifier 25 repeat
    • Replies: 4
    • Forum: Orthopaedics
  5. V

    Wiki Critical Care + Chest Tube Placement

    Hello, Friends! I've searched online and I can't find CURRENT advise re: the following scenario Provider performed critical care services for a patient for 90 minutes (99291 + 99292) and also performed a chest tube insertion (32551). I understand 99291 + 99292 does not require modifier...
    • venitacason
    • Thread
    • chest tube critical care modifier 25 modifier lt/rt
    • Replies: 1
    • Forum: Modifiers
  6. C

    Wiki special Ophthalmology codes and modifier 25

    I'm new to Ophthalmology and the company I'm working for doesn't have any credentialed coders on staff - I'm the first one. I'm questioning the use of modifier 25 on the ophthalmology codes 92002-92004 & 92012 - 92014. If the provider does a comp exam and a foreign body removal, should we be...
  7. N

    Wiki Billing Modifiers 24 and 25 Together?

    We have a patient who had a skin lesion removed. Then the patient came in within that global period for an office visit separate from the skin lesion removal. During this office visit, the patient had an EKG performed. The patient's insurance, Medicare, considers an office visit performed on the...
    • nicoleysmith
    • Thread
    • billing modifier 24 and 25 together modifier 24 modifier 25 modifiers 24 and 25
    • Replies: 5
    • Forum: Modifiers
  8. K

    Wiki Modifier 25 with OV for Scheduled Prolia/Evenity Injections

    We have a physician that does scheduled Prolia/Evenity injections. We understand that you cannot charge an OV with a -25 modifier when the purpose of the visit is for a scheduled injection. However, we have some questions for anyone who bill these injections. Our physician does a complete...
    • kfrazier
    • Thread
    • evenity modifier 25 office visits prolia
    • Replies: 2
    • Forum: Modifiers
  9. M

    Wiki Blue Shield CCI Edit Issues

    I am having issues with Blue Shield. If a patient has an office visit and is then sent for labs (in house full service laboratory) on the same day Blue Shield denies the Office Visit as global when a urine dip (81003) is billed by the lab (we operate under one tax ID number) even if we append a...
  10. K

    Wiki Modifier -25 with 99205

    Is it possible to use modifier -25 with 99205 if psychotherapy is also on the same day as a new patient E/M? Is there a better way to code this? So; 99205 -25, 90838
    • KristenB
    • Thread
    • e/m evaluation management modifier 25 psychotherapy
    • Replies: 1
    • Forum: E/M
  11. C

    Wiki 25 Modifier ONLY to be appended by certified coder?

    Hello! I am a CPC for the department OBGYN for a large medical group. just spoke with a member of management from the central billing office at my place of work, and they requested that I advise our billers that they may not append the modifier 25 to any office visit if they are not coders. I...
    • CShipitz
    • Thread
    • 25 modifier coder modifier modifier 25 modifiers
    • Replies: 7
    • Forum: Modifiers
  12. A

    Wiki Physician E&M service same day Facility Infusion

    I hope I can get someone to shed some light on this issue. physician E&M service and facility infusion on the same day- So in peds, often times, the physician ends up seeing the patient on the same day as infusion therapy that is billed by the facility. Since the clinic and infusion suite...
  13. K

    Wiki Clinic Visit/Encounter All-inclusive reported with Modifier 25

    Hello Coders, I work in Fraud, Waste and Abuse. My team is trained to look for patterns in FWA to begin investigations. The question I have today is can modifier 25 be reported on T1015 with additional services? It looks like the clinic visit replaced the E/M under most circumstances I am...
  14. L

    Wiki Billing/coding/modifiers

    I work for a small 150 bed community hospital. Our billing office contacted me today about a VA denial we received. We use the 3M encoder and it is setup to group following Medicare guidelines. My biller said the VA follows Medicare guidelines, BUT they are "behind" on being up to date with...
  15. S

    Wiki modifier 25 help

    Can anyone tell me where to find the OIG or CMS guidelines for use of modifier 25? I work in Orthopedics and there is some confusion on appending modifier 25 to E/M services when also billing an injection. I need something clear cut to give to our providers as a guide. Thanks!
  16. E

    Wiki TCM Visits

    I was wondering if someone can help me with TCM (transition of care visits). We are wanting to do a lab draw the same day but have had it denied before. Do we put a 25 modifier on the visit to get it covered? Any help would be appreciated.
  17. I

    Wiki Modifier 25 with glucose test

    Hello All, So our Family Practitioner did a preventive visit for a new patient (99385), and included a new patient E/M code (99201) for autism, and added a modifier 25 to the E/M code, which is correct. But then he also did a glucose blood test with a monitoring device (82962) because the...
  18. L

    Wiki E/M with injection same day

    I work for an orthopedic practice where the physicians see patients and do injections same day all the time. I have been trained to bill the E/M level for the visit and the injection code and append modifier 25 to the E/M level. Recently I went to an E/M workshop and the instructor told me...
    • ladymatthew
    • Thread
    • e/m injection modifier 25
    • Replies: 2
    • Forum: E/M
  19. S

    Wiki Mod 25 on Preventive w a Procedure?

    Crikey I must be having a Friday brain fart...can't find a definitive answer...not trusting myself... Patient seen for 99396 P/E + 69209 done to remove impacted wax found (No other E/M codes). I can add Mod 25 to the P/E because of the procedure, right? I need to do that, right? Agree or...
    • Sundancer
    • Thread
    • mod 25 modifier 25 modifiers p/e and modifiers preventive exams
    • Replies: 1
    • Forum: Modifiers
  20. M

    Wiki E & M on same day a Chemo

    I am having some issues with insurance companies denying (saying not seperatly identifiable) an E&M on the same day as chemo. Our docs not only have to verify that the patient is well enough to have the chemo but also wants to schedule a follow-up on the same day so that the already compromised...
  21. D

    Wiki OBGYN Modifier 25 Question

    Can someone please help. Patient comes in with suspicion of being pregnant. OBGYN does the exam to determine pregnancy then does an ultrasound to determine viability. When billing if you don't use the 25 modifier on the e/m the ultrasound gets paid and the e/m gets denied as bundled. My...
    • dsoule
    • Thread
    • modifier 25 obgyn ultrasound
    • Replies: 1
    • Forum: Modifiers
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